New procedures in endoscopy take time to be incorporated in the German diagnosis-related
groups (DRG) system. Depending on the extent of innovation and the costs, several
pathways are possible.
This article provides an overview of possible pathways to implement new procedures
in the German DRG payment system. Additionally, we compare the results of 2 surveys
on the system of New Diagnostic and Treatment Methods (Neue Untersuchungs- und Behandlungsmethoden;
NUB). Furthermore, the pathways of 2 innovations in endoscopy are described in detail
and compared with the possibilities within the legal framework.
The different pathways like NUB applications or DRG change requests and the underlying
legal framework are described in detail. The results of a survey from 2007 on the
daily practice of NUB funding in Germany show that the extent of innovations which
receive a positive assessment (status 1) is 46% compared to 43.7% in a survey from
2007, and that 77% of the status 1 procedures (and drugs) can be negotiated into a
payment - compared to 53% in the older survey.
Medical scientific societies should be involved in this process from the beginning.
Besides the importance for the hospital application process (81.3% of all medical
controllers want to have society support), the regulatory bodies (e.g. DIMDI, InEK,
G-BA) also appreciate scientific statements. Two examples show the pathways in detail.
For radiofrequency ablation of Barrett's esophagus, the pathway of continuous change
requests was chosen, while the endoluminal conduit for the treatment of type 2 diabetes
was established as NUB payment.